08120092 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CQNTRACTOR INFORMATION '•:'
BUILDING ADDRESS: PERMIT NO.
10349 JUDY AVE TBD — TO BE DE
OWNER'S NAME: PERMIT ISSUE DATE
NE: A CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG EIF.CT PLUMB MECH
0 0 0 0
fop
LICENSED CONTRACTOR'S DECLARATION Job DDSCfIpI10O
�w 1 hereby affirm Wt I am licensed under provisions of Clepicr 9(commencing
Z with Saction70 I.Miviim.3.fthc Business and Profcssiuns Code,and my license is
n_,,H immUrorecanealfcct INSTL NEW FURNACE, A/C& TNKLESS WTR HEATER
)ZJZ License Class L'e.N
DOW�outermost
ARCHITECTS DECLARATION
I understand my plans+hail he used as public rce.rds
Jou
g o Licensed Professional
N
a�"3 OWNER-BUILDER DECLARATION
f 1 Wrathy afri m m 1 am exemptm train the Contractors License Law for On
r prO following reason.(settle.707 L5,Business and Professions; Any city at county
o
5_0! which requires a permit to convmct,alter,improve,demolish or miner any suuttmc
_Z< priono its houinco,aha requires theapplicmt for such permit to file.signed sutamenl
m duuheulicensed personaltothe pmvisiomm
aftheConcun'sUeenseLaw(Clupkr9 Sq.FL Floor Area Valuation
Yl-$ (commencing with Section 7")Of Division J of the Business and Profosiav Cape)or
e — that M u concept thcmfrom and the basis for the alleged exemption.Any violation of S6000
SeNon 7031.5 by any applicant for a permit subjcc,thc applicant in a civil penalty of APN Number Occupancy Type
not mom than five hundred dollars(5500). p y yp
❑1,uownerofthepmpcny,mmyemploycuwithwagexutheirsolec Nmdon, 37508 Q49 . OO
Will do tha work and the sane¢¢is not intended oraaered forsale(Sec.7044,Business
and Pmfealan,Cade The Camnctora Lien¢law does oat apply k an manner Of Required Inspections
property who builds Or improves theraan,and who doessuch walk himself or through his
own employees,provided that such improvements art not inmMed oroResW forple IL
however.the building or improvement is sold within am yea of completion.the owner.
builder will have the burden of pmving that he did not build or improve for purpose of
sated.
0'L as owner of the property am exclusively conuacung with licensed cea==he
construct the pri IS=7044,Business and Profession,Cade:)The Contractors Li-
cense Law does not apply to an owner of property who builds or improves aereen,and
who contracts for such projects with a eantratcor(s)licensed parsaant in the Contractors
License law.
❑Icer exempt g�cjg/See .B d:P C for this mason
Owner ` Data
WORKERS COMPENSATION DECLARATION
1 by an..under pen,lty of perjury am of don following declua0mmc
I ham and will maintain a Certificate Consent self
of Conseno -insum for WorkcesCompcn-
lion.u provided for by Section 3700 of the Tabor Code,for the performance of the
were for which this permit is issund.
❑1 have and will maintain Worked Compensation h surance,as rcquirtd by Section
3700 a the labor Code,for the pertormurce of the work for which this permit is Wald.
My Workers Compensation Insurance carrier and Policy number art:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CITU section nand Out he complemd ifuse permit Is foram hundred dollars(5100)
Or less)
T certify thus in the performance of the work for which this permit u issued.1 shell not
employ any person in anymmmrm as in bete esubjcetmth\mrken'Campcn,ation
Laws of California.Dak�,Lj�T�A
Appli ant
NOTICE TO APPL} .If,after making this CcniRcek of Exemption,you should
booan subject u)Ahe Worked Compcmadon pmvisiom of Nc labor Cade,you mast
,J O faMwas campss mh such provisimas or Nu permit shall be doomed revolted.
Z2
CONSTRUCTION TENDING AGENCY
[—m Ihemh wrm Nat there is a construction lending agency for the performance of
[� > the work for which th n permit is Wood(Sm.3097,Civ.C.)
ILl Landers Name
.7 z Landers Address -
O Q I cattily that I have mad this application it same Nat the above information la
Iy F cont+I agree to comply with ill city and county mNinamces and state laws misting in
0 U building construction.and hereby stabilize representatives alums city to enter upon the
y +hove-mentioned pmperty for inspection purposes
(We)agree to ave,indemnify and keep harmless the City of Cupcnino agaunt
liabilitio.judgmcnts.com and expenses which may in any way accrue ageinu said City
U Z in consequence of Ne granting of this permit
'--' APPLICANT UNDERSTA AND WILL COMPLY W1711ALL NON-POINT Issued by: Date
SOURCEREGULATIO
�Da ° Re-roofs
Signawrt of Appli UCamnctor Dam
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof t
VIII Ne pplinnt or future building Oceupanurorc or handle havNom material
u dented by Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Calk.Section 25532(+)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes kI.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it bavard.m air contaminants.Outlined by the Bay Area Air Quality Man.gamer all new materials for inspection.
strict?
❑Yes XNu
I have mail the hvardous makriah requirements under Chapter 6.95 ofthe Califor.
nia Health A Safety Cade,Sections;25505.25533 and 25534.1 understand WSIlan building
does not currently hove a tenant Naz it is my ampan,ibility in nodfy the Occupant of the
mgUlmmentswhich mtbemapdorkissuamcof&Cmrmkafaapanty. Signature of Applicant Date
/i it _c
Owner ser threcd ager DaviAll roof coverings to be Class'A"or better
'
CITY OF CUPERTINO
s 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37508049 . 00
DATE ISSUED. . . . . . . : 12/12/2008
RECEIPT # . . . . . . . . . : BS000006814
REFERENCE ID # . . . : 08120092
SITE ADDRESS . . . . . : 10349 JUDY AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : YANPING WANG
ADDRESS . . . . . . . . . . : 10349 JUDY AVE
' CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : EDDY Z SHEN
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------- -------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
IMRRAA UNITS 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1PRWHEATR UNITS 1 . 00 24 .48 0 . 00 24 .48 0 . 00
ITRAVDOC ' FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00
TOTAL PERMIT 249 .43 0 . 00 249 .43 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------------- ------ -------
CREDIT CARD 249 . 43 VISA
TOTAL RECEIPT 249 . 43
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ------ -------
--- ----- ---------------
518 WATER HEATER
•
a' CITY OF CUPERTINO
FURNACE/AC
C1 OF
•CUPERTINO PERMIT APPLICATION FORM
APN# 2 a Date:
-��'—
Building Address:
t 11�a� ,►u A4
Owner's Name: �A-N Pl Phone#: ,I 6 6
a �✓ -
Contractor: Phone #:
Fax #:
Contractor License#: Cupertino Business License#:
Contact: Phone#:
Fax #:
Building Permit Info:
Elect �— Plumb [lf Mech [�--
Residential Commercial ❑
Job Description: I I yxp UL:. �0' / f U,L4AW
For Residential Installations:
Attic I" floor 2"d floor ❑
Adhere to minimum setback requirement Gil
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural c_alcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construct.on (Usage Class):
N -
Strapped El On Platform El Bonded New Location Replacement
Project Size: Express 9--Standard ❑ Large ❑ Major❑
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist & attach itsq the
application or if applicable, include in plan set & the sheet index.
Revised 6/16/08
CITY OF CUPERTINO d
FURNACE/AC
OF
CUPERTINO FEE SCHEDULE •
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1MCRAA Commercial-Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system;incl
installation of controls regulated by this
code.
1 MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1MCSUSHTR Commercial Install/Relocate ea M
suspended heater,recessed wall htr, or •
floor mounted unit heater.
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed & not incl in an appliance
permit. _
1BSEISMICO Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1MRAPPVNT Residential for the install/relocate/or M
replacement of ea appliance vent
install & not incl in an appl permit.
Quantity Fee ID Fee Description Fee Permit Type
(: n